Liewen C, Krenn V T, Dieckmann R, Bause L, Liebisch M, Niemeier A, Trampuz A, Krenn V
MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik Trier GmbH, Max-Planck-Straße 5, 54296, Trier, Germany.
Fakultät für Medizin, Sigmund Freud PrivatUniversität Wien, Vienna, Austria.
Z Rheumatol. 2022 May;81(4):342-351. doi: 10.1007/s00393-020-00941-w. Epub 2020 Dec 11.
The purpose of this study is to use the CD15 focus score (FS) to determine the sensitivity and specificity of bacterial infection persistence in spacer-based two-stage revision arthroplasty.
The analysis comprises 112 cases that were subjected to revision due to the presence of infection upon replacement of a joint endoprosthesis. The histopathological data were collected in accordance with the synovial-like interface membrane (SLIM) classification and the CD15-FS and correlated with the microbiological data (MD). The quantifying evaluation of the CD15-FS was performed without knowledge regarding the microbiological data (MD). Correlation with the MD was performed after a 14-day cultivation period.
With a single evaluation (1 focus, field area: 1.2 mm2) with a score value of 42, the CD15-FS showed a sensitivity for the eradication of infections of 0.64 and a specificity of 0.79 (PPV = 0.5; NPV = 0.87). With tenfold evaluation (10 foci, field area: 12 mm2) with a score value of 220, the sensitivity for the eradication was 0.68, the specificity 0.91 (PPV = 0.7; NPV = 0.89). No statistically significant correlation between the score values and the different infectious species could be detected. Based on the MD in 112 cases the rate of infection eradication was 75%. Polymethylmethacrylate-particles (PMMA) were detected in the perispacertissue in 64 cases (58%). No significant correlation could be established between microbiological pathogen detection and the presence of PMMA.
In all cases (n = 112), periimplant synovial tissue (SLIM) with variable fibroblastic cellularity, capillary proliferation, leukocytic infiltration, fibrin deposition, new formation of woven bone and detection of PMMA particles was observed. These cases were classified as type IX perispacer synovialis/SLIM: type IX‑A with histopathological infection eradication and type IX‑B with histopathological infection persistence.
本研究旨在使用CD15聚焦评分（FS）来确定基于间隔器的两阶段翻修关节成形术中细菌感染持续存在的敏感性和特异性。
分析包括112例因关节假体置换时存在感染而接受翻修的病例。根据滑膜样界面膜（SLIM）分类收集组织病理学数据以及CD15-FS，并与微生物学数据（MD）相关联。CD15-FS的定量评估在不了解微生物学数据（MD）的情况下进行。在14天培养期后进行与MD的相关性分析。
单次评估（1个病灶，视野面积：1.2 mm2），评分为42时，CD15-FS显示感染根除的敏感性为0.64，特异性为0.79（阳性预测值=0.5；阴性预测值=0.87）。十次评估（10个病灶，视野面积：12 mm2），评分为220时，根除的敏感性为0.68，特异性为0.91（阳性预测值=0.7；阴性预测值=0.89）。未检测到评分值与不同感染菌种之间存在统计学显著相关性。基于112例病例的MD，感染根除率为75%。在64例（58%）的间隔周围组织中检测到聚甲基丙烯酸甲酯颗粒（PMMA）。微生物病原体检测与PMMA的存在之间未建立显著相关性。
在所有病例（n = 112）中，观察到植入物周围滑膜组织（SLIM）具有可变的成纤维细胞密度、毛细血管增生、白细胞浸润、纤维蛋白沉积、编织骨新形成以及PMMA颗粒的检测。这些病例被分类为IX型间隔周围滑膜炎/SLIM：IX-A型为组织病理学上感染根除，IX-B型为组织病理学上感染持续存在。
